1/3 PHOEBES AMPS 136 +2 99 +5 99 pmps 146

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Phoebes, Jan 3, 2018.

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  1. Phoebes

    Phoebes Well-Known Member

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    Jan 16, 2017
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  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Angela asked if I'd take a look at Phoebe's SS and see where she's at with regard to a reduction.

    Here's the part you'll likely hate. There's really no way to know. The only way you know if a dose needs to be reduced is if the kitty's numbers drop, thus warranting the reduction. It does look like she's inching her way down and Phoebe's numbers have been looking good -- lots of blues and greens -- so it's possible she may be aiming to go into dose reduction territory. There are two issues which complicate the picture, though. The first is that Phoebe is a high dose cat. Depending on what the HD condition is, it may make a difference with regard to the size of a reduction when it happens. The other issue, and again, this may differ for a HD kitty (I'm tagging @Wendy&Neko), is that after a year, the point at which a reduction occurs is if numbers drop below 40. (In your signature, is the date of dx 12/2016?)



     
  3. carfurby

    carfurby Well-Known Member

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    Feb 19, 2012
    I hope the pudding poo clears up soon. Sending prayers. :bighug::bighug:
     
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  4. Phoebes

    Phoebes Well-Known Member

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    Yes.
     
  5. Phoebes

    Phoebes Well-Known Member

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    Thank you @Sienne and Gabby (GA) all this discussion about reductions, long term short term, just had my head spinning. I missed that you can earn reduction other than going below 50 on a human meter. So ty.
     
  6. Phoebes

    Phoebes Well-Known Member

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  7. Nan & Amber

    Nan & Amber Well-Known Member

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    I'm also curious about this. I'm guessing that the argument for the new cutoff for long-term diabetics is that you want to be more conservative about dose changes, particularly reductions, rather than bopping up and down the dose ladder all the time, because a long-term diabetic has shown that she's not on the fast-track to remission and is unlikely to have major changes in insulin needs in the short term. But with HD conditions, my understanding is that sometimes the insulin needs can change very rapidly-- when the antibodies finally break in IAA, or if an acro tumor pulses on and off-- so it seems like maybe you don't have to take that conservative approach to reductions? Unless my very rudimentary cartoon view of the nature of HD conditions changes when a kitty becomes a long-term diabetic, too. Curious to hear what the typical approach is!

    Take that, pudding poos! Can't keep a good kitty down!
     
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  8. Phoebes

    Phoebes Well-Known Member

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    That made me laugh!
     
  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    @Nan & Amber - While as time passes, the likelihood of remission is more unlikely. However, Devon's Mocha decided she'd had enough of this diabetes nonsense after 3 years. Chris' China was diagnosed on 2013. Cats always keep us guessing.
     
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  10. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Yes, a high dose kitty is a bit more complicated. There is a saying "Know Thy Cat". That saying is even more true for high dose kitties. We don't know if Phoebe has IAA or acromegaly, because she hasn't been tested, but we can guess. I suspect not IAA because her spreadsheet doesn't look like it. So we are talking acromegaly. The tumour can pulse up and down, but not what I'd call "very rapidly". IAA can make for some quicker reductions than acro.

    I never followed the guideline to wait until drops below 40 when Neko passed her one year diagnosis mark. Actually, I tried doing the three drops under 50 once and abandoned it when she quickly hit the 30's. Another time I was conservative on reduction size and she hit the 20's. Lesson learned, I did reductions below 50. When the acro tumour went down, it meant Neko needed less insulin and she usually held her reductions. That's what I learned about my cat. If she was at a dose that was giving me nadirs in the 70's, that was ideal. It meant less bouncing and most of the time under renal threshold. Of course, when the IAA was breaking or just after SRT when reductions were fast and furious, I modified it to reductions under 70, to give me some margin. Then back to 50 when things slowed down.

    Phoebe seems to be giving you nadirs in the 60's, and overall looks pretty good. If you find you are losing too much sleep at night monitoring. you have one of two options. Sometimes I would take a break and do a temporary dose reduction for a few cycles so I could get some sleep. Then I would take the dose back up when I caught up on sleep. Sometimes those temporary reductions held. Option 2 is to try a reduction and see if you like what it gives you. As for size of dose change, typically we do 1 unit changes at this size dose, but you could also try a 0.5U change and see if it just brings the nadirs up enough to be easier on you. Some high dose cats respond to smaller dose changes. Time to experiment and see what works best for Phoebe.
     
    Last edited: Jan 3, 2018
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